Indonesia is disrupting the 50-year-
old system that supplies the world with flu vaccines by
demanding compensation from drugmakers GlaxoSmithKline Plc and
Novartis AG.
Siti Fadilah Supari, Indonesia's Health Minister, stopped
sending the World Health Organization live viruses taken from
birds and humans that scientists use for vaccines in December.
Supari said shipments will resume only after the WHO helps
Indonesia negotiate free supplies of pandemic-flu shots and
money to build vaccine plants, the first-ever such requirement.

Without the latest versions of the avian-influenza virus,
doctors can't produce the most up-to-date vaccines. The WHO said
last week it will press companies to meet some of Indonesia's
needs. Glaxo Chief Executive officer Jean-Pierre Garnier will
meet with WHO director-general Margaret Chan today to discuss
the dispute, said Nancy Pekarek, a company spokeswoman for the
London-based drugmaker.

``I cannot tolerate this misuse of our viruses,'' said
Triono Soendoro, who runs the flu research for Indonesia's
health ministry. His Jakarta lab stores the samples Indonesia
says it will withhold until an agreement is brokered.

Indonesians spend an average of $30 annually on health
care, compared with $5,700 in the U.S., according to the World
Health Report. Glaxo's flu vaccine costs $6 to $11 a shot in
markets around the world, and receiving a flu shot from a doctor
can cost as much as $59 in Jakarta.

....

The WHO is working on an agreement that would cover access
to seasonal and avian flu, including the H5N1 virus WHO says has
killed at least 170 people since late 2003, mostly in Asia.

Following a two-day meeting last week with Indonesia,
Thailand and other nations hit by avian flu, WHO officials
pledged to develop new guidelines regulating how the agency
distributes viruses now provided free by poor nations.

The new rules may require the WHO to disclose for the first
time which companies use the viruses to make vaccines, said
David Heymann, the agency's assistant director general for
communicable diseases, who met with the countries' health
officials in Jakarta. WHO also will ask the drugmakers to
provide free vaccine for use by poorer countries, Heymann said

The article goes on to note something that I haven't seen yet in the mainstream press, or by WHO itself, though it's been more or less obvious to people following the news: The WHO has stopped acknowledging/confirming cases of H5N1 in Indonesia. On its website, the number of cases and deaths in that country hasn't budged since the last "Situation Update" on January 29.

Of course, blogs have been closely following local news sources, so we can be pretty confident that the current count, as of April 6, is: 93 cases and 73 deaths.

It's not clear whether this is because Indonesia has stopped reporting cases to the WHO (at all), or whether the WHO has stopped confirming those reports. However, we know that the WHO had been providing updates (including reports of 5 deaths) through the end of January, a full month after they stopped receiving viral samples, so clearly it's not impossible for the WHO to confirm deaths from H5N1 without having access to viral samples for each individual case.

Either way, to me it suggests a severe breakdown in cooperation that goes far beyond the debate about ownership of physical viral samples.